The unity and diversity of verbal and visuospatial creativity: Dynamic changes in hemispheric lateralisation.

The investigation of similarities and differences in the mechanisms of verbal and visuospatial creative thinking has long been a controversial topic. Prior studies found that visuospatial creativity was primarily supported by the right hemisphere, whereas verbal creativity relied on the interaction between both hemispheres. However, creative thinking also involves abundant dynamic features that may have been ignored in the previous static view. Recently, a new method has been developed that measures hemispheric laterality from a dynamic perspective, providing new insight into the exploration of creative thinking. In the present study, dynamic lateralisation index was calculated with resting-state fMRI data. We combined the dynamic lateralisation index with sparse canonical correlation analysis to examine similarities and differences in the mechanisms of verbal and visuospatial creativity. Our results showed that the laterality reversal of the default mode network, fronto-parietal network, cingulo-opercular network and visual network contributed significantly to both verbal and visuospatial creativity and consequently could be considered the common neural mechanisms shared by these creative modes. In addition, we found that verbal creativity relied more on the language network, while visuospatial creativity relied more on the somatomotor network, which can be considered a difference in their mechanism. Collectively, these findings indicated that verbal and visuospatial creativity may have similar mechanisms to support the basic creative thinking process and different mechanisms to adapt to the specific task conditions. These findings may have significant implications for our understanding of the neural mechanisms of different types of creative thinking.

Sympathetic Blocks as a Predictor for Response to Ketamine Infusion in Patients with Complex Regional Pain Syndrome: A Multicenter Study.

BACKGROUND: Ketamine infusions are frequently employed for refractory complex regional pain syndrome (CRPS), but there are limited data on factors associated with treatment response. Sympathetic blocks are also commonly employed in CRPS for diagnostic and therapeutic purposes and generally precede ketamine infusions. OBJECTIVES: We sought to determine whether demographic and clinical factors, and technical and psychophysical characteristics of sympathetic blocks are associated with response to ketamine infusion. METHODS: In this multi-center retrospective study, 71 patients who underwent sympathetic blocks followed by ketamine infusions at 4 hospitals were evaluated. Sympathetically maintained pain (SMP) was defined as ≥ 50% immediate pain relief after sympathetic block and a positive response to ketamine was defined as ≥ 30% pain relief lasting over 3 weeks. RESULTS: Factors associated with a positive response to ketamine in univariable analysis were the presence of SMP (61.0% success rate vs 26.7% in those with sympathetically independent pain; P = .009) and post-block temperature increase (5.66 ± 4.20 in ketamine responders vs 3.68 ± 3.85 in non-responders; P = .043). No psychiatric factor was associated with ketamine response. In multivariable analysis, SMP (OR 6.54 [95% CI 1.83, 23.44]) and obesity (OR 8.75 [95% 1.45, 52.73]) were associated with a positive ketamine infusion outcome. CONCLUSIONS: The response to sympathetic blocks may predict response to ketamine infusion in CRPS patients, with alleviation of the affective component of pain and predilection to a positive placebo effect being possible explanations.

MAGI2-AS3 inhibits breast cancer by downregulating DNA methylation of MAGI2.

Breast cancer is one of the most threatening diseases for women. Long noncoding RNAs were reported to be involved in breast cancer development. In this study, we analyzed The Cancer Genome Atlas breast cancer tissue high-throughput sequencing data and screened and validated the low-expressing long noncoding RNA named MAGI2-AS3. Through gene coexpression analysis, we found that MAGI2-AS3 has a good expression correlation with MAGI2. Overexpression of MAGI2-AS3 or MAGI2 in breast cancer cells MCF-7 would inhibit the Wnt/ß-catenin pathway and inhibit cell proliferation and migration. Gene structure and DNA methylation analysis results indicated that MAGI2-AS3 may act as a cis-acting regulatory element downregulating the DNA methylation level of the MAGI2 promoter region, and the DNA demethylase TET1 inhibitor can reverse MAGI2-AS3 overexpression caused upregulation of MAGI2 and cellular effects. Our findings reveal the role of MAGI2-AS3 in breast cancer and provide potential novel therapeutic targets for metastatic breast cancer intervention.

CircRNA inhibits DNA damage repair by interacting with host gene.

BACKGROUND: Deregulated circular RNAs (circRNAs) are associated with the development of cancer and therapy resistance. However, functional research of circRNAs mostly focus on potential miRNA or protein binding and more potential regulation of circRNA on host gene DNA in cancers are yet to be inspected. METHOD: We performed total RNA sequencing on clinical breast cancer samples and identified the expression patterns of circRNAs and corresponding host genes in patient blood, tumor and adjacent normal tissues. qPCR, northern blot and in situ hybridization were used to validate the dysregulation of circRNA circSMARCA5. A series of procedures including R-loop dot-blotting, DNA-RNA immunoprecipitation and mass spectrum, etc. were conducted to explore the regulation of circSMARCA5 on the transcription of exon 15 of SMARCA5. Moreover, immunofluorescence and in vivo experiments were executed to investigate the overexpression of circSMARCA5 with drug sensitivities. RESULTS: We found that circRNAs has average higher expression over its host linear genes in peripheral blood. Compared to adjacent normal tissues, circSMARCA5 is decreased in breast cancer tissues, contrary to host gene SMARCA5. The enforced expression of circSMARCA5 induced drug sensitivity of breast cancer cell lines in vitro and in vivo. Furthermore, we demonstrated that circSMARCA5 can bind to its parent gene locus, forming an R-loop, which results in transcriptional pausing at exon 15 of SMARCA5. CircSMARCA5 expression resulted in the downregulation of SMARCA5 and the production of a truncated nonfunctional protein, and the overexpression of circSMARCA5 was sufficient to improve sensitivity to cytotoxic drugs. CONCLUSION: Our results revealed a new regulatory mechanism for circRNA on its host gene and provided evidence that circSMARCA5 may serve as a therapeutic target for drug-resistant breast cancer patients.

Mechanistic insight into selective catalytic combustion of HCN over Cu-BEA: influence of different active center structures.

HCN being a highly toxic N-containing volatile organic compound (VOCs) poses great threat to human living environment. Selective catalytic combustion of HCN (HCN-SCC) over metal modified zeolite catalysts has attracted great attention due to related high efficiency and excellent N2 selectivity. In the present work, three types of 24T-Cu-BEA models with different active centers of single [Cu]+, double [Cu]+, and [Cu-O-Cu]2+ were constructed for HCN-SCC mechanism simulations based on density functional theory (DFT). DFT simulation results revealed that HCN-SCC followed an oxidation mechanism over double [Cu]+ through an intermediate of NCO, wherein the synergistic effects of double [Cu]+ active centers were clearly observed, resulting in a significantly lowered energy barrier (1.6 kcal mol-1) during HCN oxidation into NCO. However, an oxidation mechanism (HCN oxidized into NH radical and CO2 through intermediate of HNCO) combining with a hydrolysis mechanism (NH radical hydrolyses into NH3) occurred over single [Cu]+ and [Cu-O-Cu]2+, wherein the NH2 hydrolysis to NH3 step was regarded as the rate determining step with an energy barrier of 72.3 and 74.3 kcal mol-1, respectively. Finally, Mulliken charge transfer (CT) analysis was conducted, based on which the electric properties of different active centers were well illustrated.

Mechanistic insight into selective catalytic combustion of acrylonitrile (C2H3CN): NCO formation and its further transformation towards N2.

A series of zeolite catalysts, M(Cu, Fe, Co)-ZSM-5, was prepared by an impregnation method and evaluated for the selective catalytic combustion of acrylonitrile (AN-SCC). Cu-ZSM-5, exhibiting the highest AN conversion activity and best N2 yield, was further selected for an AN-SCC mechanism investigation, wherein both experimental [in situ diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS)] and theoretical [density functional theory (DFT)] approaches were employed. The in situ DRIFTS revealed that AN-SCC followed a hydrolysis mechanism at T < 300 °C via intermediates of acylamino species (-CONH2) and NH3, while it followed an oxidation mechanism at T > 300 °C via an intermediate of NCO. The DFT simulations gave much deeper insights suggesting that: (i) the NCO could be generated by oxidation of AN over [Cu]+ active sites, with an assistance of dissociated atomic O from gaseous O2; (ii) three types of reaction routes could be proposed for the further reaction of NCO to produce N2, namely NCO direct dissociation, NCO coupling, and NO + NCO reaction; and (iii) the last route (NO + NCO), possessing the lowest energy barrier, was the most probable reaction pathway, wherein the NO could be produced by oxidation of NCO. The DFT energy calculation results and microkinetic analyses revealed that the NCO generation step, possessing an energy barrier of 17.0 kcal mol-1 and a forward reaction rate constant of 2.20 × 107 s-1, was the rate-determining step of the whole catalytic cycle.

METTL3 orchestrates glycolysis by stabilizing the c-Myc/WDR5 complex in triple-negative breast cancer.

BACKGROUND: The carcinogenic transcription factor c-Myc is the most aggressive oncogene, which drive malignant transformation and dissemination of triple-negative breast cancer (TNBC). Recruitment of many cofactors, especially WDR5, a protein that nucleates H3K4me chromatin modifying complexes, play a pivotal role in regulating c-Myc-dependent gene transcription, a critical process for c-Myc signaling to function in a variety of biological and pathological contexts. For this reason, interrupting the interaction between c-Myc and the transcription cofactor WDR5 may become the most promising new strategy for treating c-Myc driven TNBC. METHODS: Immunoprecipitation and mass spectrometry (IP-MS) is used to screen proteins that bind c-Myc/WDR5 interactions. The interaction of METTL3 with c-Myc/WDR5 in breast cancer tissues and TNBC cells was detected by Co-IP and immunofluorescence. Subsequently, we further analyzed the influence of METTL3 expression on c-Myc/WDR5 protein expression and its interaction stability by Western blot and Co-IP. The correlation between METTL3 and c-Myc pathway was analyzed by ChIP-seq sequencing and METTL3 knockdown transcriptome data. The effect of METTL3 expression on c-Myc transcriptional activity was detected by ChIP-qPCR and Dual Luciferase Reporter. At the same time, the overexpression vector METTL3-MUT (m6A) was constructed, which mutated the methyltransferase active site (Aa395-398, DPPW/APPA), and further explored whether the interaction between METTL3 and c-Myc/WDR5 was independent of methyltransferase activity. In addition, we also detected the changes of METTL3 expression on TNBC's sensitivity to small molecule inhibitors such as JQ1 and OICR9429 by CCK8, Transwell and clonal formation assays. Finally, we further verified our conclusions in spontaneous tumor formation mouse MMTV-PyMT and nude mouse orthotopic transplantation tumor models. RESULTS: METTL3 was found to bind mainly to c-Myc/WDR5 protein in the nucleus. It enhances the stability of c-Myc/WDR5 interaction through its methyltransferase independent mechanism, thereby enhancing the transcriptional activity of c-Myc on downstream glucose metabolism genes. Notably, the study also confirmed that METTL3 can directly participate in the transcription of glucose metabolism genes as a transcription factor, and knockdown METTL3 enhances the drug sensitivity of breast cancer cells to small molecule inhibitors JQ1 and OICR9429. The study was further confirmed by spontaneous tumor formation mouse MMTV-PyMT and nude mouse orthotopic transplantation tumor models. CONCLUSION: METTL3 binds to the c-Myc/WDR5 protein complex and promotes glycolysis, which plays a powerful role in promoting TNBC progression. Our findings further broaden our understanding of the role and mechanism of action of METTL3, and may open up new therapeutic avenues for effective treatment of TNBC with high c-Myc expression.

Current State, Needs, and Opportunities for Wearable Robots in Military Medical Rehabilitation and Force Protection.

Despite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots. Panelists presented current wearable robots currently in use or in development for rehabilitation or assistance use in the military workforce and healthcare. The steering group and panelists met to obtain a consensus on the wearable robot definition applicable for rehabilitation or primary injury prevention. Panelists unanimously agreed that wearable robots can be grouped into three main applications, as follows: (1) primary and secondary MSK injury prevention, (2) enhancement of military activities and tasks, and (3) rehabilitation and reintegration. Each application was presented within the context of its target population and state-of-the-art technology currently in use or under development. Capturing expert opinions, this study defines wearable robots for military rehabilitation and MSK injury prevention, identifies health outcomes and assessment tools, and outlines design requirements for future advancements.

Diagnostic ultrasound of the residual limb: A narrative review.

Globally, 57.7 million people lived with traumatic limb loss in 2017, with the prevalence of amputation in the United States alone expected to reach 3.6 million by 2050. Pain is a common complication after limb loss, with up to 59% of patients experiencing residual limb pain (RLP). Although RLP is often due to a structural etiology, it is difficult to treat because the exact structure involved is frequently not apparent on history and physical examination alone. This narrative review aims to summarize the available literature on diagnostic ultrasound of the residual limb and examine the utility of ultrasound in identifying specific pathology. A total of 31 peer-reviewed manuscripts published between 1989 and 2021 were included, grouped by pathology. Although ultrasound presents a promising and cost-effective approach to identifying pathology within the residual limb, many gaps remain in the current knowledge, and no specific protocol for a sonographic assessment of the residual limb has ever been proposed. Future studies of diagnostic ultrasound of the residual limb should focus on replicable sonographic techniques and standardized exam protocols.

LncRNA MIR17HG Suppresses Breast Cancer Proliferation and Migration as ceRNA to Target FAM135A by Sponging miR-454-3p.

Breast cancer is one of the most common malignant tumors in women, and causes a large number of cancer-related deaths. The main cause of death of breast cancer patients is tumor recurrence and metastasis. Recent studies show that lncRNA (Long non-coding RNA) plays an important role in breast cancer. However, the overall biological activity and clinical consequences of the lncRNA MIR17HG in breast cancer remain unclear. Thus, we investigate how the MIR17HG/miR-454-3p network impacts breast cancer cell proliferation and migration. Given the TCGA and Oncomine databases, the researchers evaluated variations in MIR17HG expression for the survival rates of breast cancer patients. The influence of MIR17HG on cell proliferation, migration, cell cycle, and the mRNA expression level of miR-454-3p and FAM135A (family with sequence similarity 135 member A) is identified. Luciferase assay was used to detect the regulatory effect of miR-454-3p on the 3'UTR region of FAM135A, and rescue experiments demonstrated that MIR17HG can up-regulate FAM135A expression by competitively binding miR-454-3p. The effect of FAM135A on the cloning and invasion of MCF-7 cells was detected. MIR17HG expression is reduced in breast cancer tissues, and patients with greater levels of MIR17HG expression have a better prognosis. MIR17HG overexpression caused G2/M arrest in breast cancer cells according to a flow cytometry assay. FAM135A knockdown enhances breast cancer cell proliferation and clone creation, as well as two-dimensional and three-dimensional migratory capacities. Patients with high FAM135A expression in their breast cancer had a better prognosis. These novel findings indicate that MIR17HG may be a potential target for breast cancer. Our findings demonstrated that MIR17HG might suppress breast cancer cell proliferation and migration by sponge miR-454-3p through ceRNA(competing endogenous RNAs) mechanism, indicating that targeting MIR17HG may be a feasible therapeutic candidate for breast cancer.

Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study.

Objectives: To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI). Setting: An inpatient rehabilitation department of a teaching hospital in China. Design: Retrospective chart review. Methods: A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected. Results: A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively. Conclusion: UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.

Mettl3 synergistically regulates TGF-ß/SMAD2/3 to promote proliferation and metastasis of gastric cancer.

Transforming Growth factor-ß (TGF-ß)/Smad signaling is a complex regulatory network that both inhibits and promotes tumorigenesis. However, the mechanisms underlying the function of TGF-ß/Smad signaling pathway remain to be fully elucidated. As a methyltransferase, METTL3 is closely related to tumor development, but the role of METTL3 in the proliferation and metastasis of TGF-ß/Smad-activated gastric cancer (GC) is unclear. In this study, we identified TGF-ß/Smad2/3 axis as an important carcinogenic pathway in GC, which significantly promoted the proliferation and metastasis of GC. Furthermore, we found that Smad3 mRNA could be modified by m6A, which was subsequently recognized and stabilized by IGF2BP2, thereby enhancing Smad3 protein expression and promoting the activation of TGF-ß/Smad pathway. Importantly, we also found that METTL3 could combine with p-Smad3 to regulate the transcription of downstream target genes. Therefore, this study revealed a novel mechanism by which METTL3 synergistically regulates TGF-ß/Smad2/3 signaling and provide a new potential therapeutic target for the treatment of GC.

IGF2BP2-modified UBE2D1 interacts with Smad2/3 to promote the progression of breast cancer.

Recent studies have suggested that ubiquitin-conjugating enzyme E2D1 (UBE2D1) is involved in tumor progression. In this study, we found that UBE2D1 expression was upregulated in breast cancer (BC) and was related to the prognosis of BC patients. Through in vitro and in vivo experiments, we demonstrated the aberrant expression of UBE2D1 promoted the proliferation and migration of BC cells, and the IGF2BP2-mediated N6-methyladenosine (m6A) modification increased the stability of UBE2D1 mRNA. Mechanistically, UBE2D1 expression regulated the activity of TGF-ß signaling through modulating the expression and the phosphorylation level of Smad2/3. Furthermore, UBE2D1 directly bound to Smad2/3 and affected the subsequent binding of Smad2 and Smad3, which is a necessary step for TGF-ß signaling activation. Thus, our study reveals a pro-oncogenic role of UBE2D1 in the progression of BC and may provide novel strategies for BC treatment.

Reliability of point-of-care shoulder ultrasound measurements for subacromial impingement in asymptomatic participants.

Background: Rehabilitation is the key to management of patients with subacromial impingement syndrome to prevent disability and loss of function. While point-of-care musculoskeletal ultrasound aids clinical diagnosis of subacromial impingement syndrome, many patients do not demonstrate the classic findings of dynamic supraspinatus tendon impingement beneath the acromion on ultrasound. The objective of this study was to establish the most reliable shoulder ultrasound measurements for subacromial impingement, by evaluating the intra-rater and inter-rater reliability of measurements in asymptomatic participants. Methods: Eighteen participants (9 women, 9 men, mean ± standard deviation: 34.6 ± 7.9 years of age) underwent bilateral shoulder ultrasound evaluations with measurements for subacromial impingement (acromiohumeral distance, acromion-greater tuberosity distance, supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness) performed by two sports medicine physicians. Intra-class coefficients were calculated to determine the intra- and inter-rater reliability of shoulder ultrasound images and measurements. Results: Intra-rater reliability for acromiohumeral distance (0.76-0.79), supraspinatus tendon (0.91-0.95), subacromial-subdeltoid bursa (0.76-0.84), and subacromial-subdeltoid bursal fluid thickness (0.75-0.81) was found to be good to excellent, whereas inter-rater reliability ranged from poor to moderate. Conclusions: Acromiohumeral distance in neutral position and short axis ultrasound measurements of supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness in the modified Crass position were the most reliable for subacromial impingement in asymptomatic participants. We recommend validation of these measurements in a symptomatic population to aid diagnosis and direct rehabilitation of patients with suspected subacromial impingement, and to increase point-of-care ultrasound uptake, availability, and training among rehabilitation professionals across health systems.

Use of Non-Specific Knee Diagnoses and Incidence of Obscure Knee Injuries in a Large Government Health System.

Purpose: Within a large government health system, to assess the practice of using non-specific diagnoses for knee disorders and determine how often they appear as the only diagnosis without more specificity. The secondary purpose was to identify the incidence of obscure knee disorders diagnosed: pes anserine bursitis, prepatellar bursitis, pigmented villonodular synovitis, and plica syndrome. Patients and Methods: Eligible beneficiaries of the Military Health System (MHS) seeking care for a knee disorder between 1 January 2009 and 31 December 2013 with at least 2-year follow-up. Data were sourced from the MHS Data Repository. The study outcomes were 1) utilization rate of non-specific knee diagnosis codes, 2) proportion of cases that never received a specific knee diagnosis, 3) incidence of obscure knee pathology in this cohort. Results: There were 127,570 beneficiaries seeking care for knee pain during this period. While the majority (99.7%) initially received a non-specific knee diagnosis, these occurred in isolation for only 16.5% of the cases (n=20,042) over two-year follow-up. The use of non-specific codes was similar between military and civilian clinic settings (45.3% and 47.0%, respectively, of all knee disorders diagnosed), which appears to reflect clinical practice in which diagnoses become more specified over time and diagnostic workup aims to exclude competing diagnoses. The incidence of obscure knee pathology was small (0.2% to 4.0%). Conclusion: Most of the cohort (99.7%) received a non-specific diagnosis at their initial visit, but only 15% did not eventually receive a more specific diagnostic code. These findings suggest that diagnoses may become more specific over time as condition-specific signs and symptoms become more evident, and diagnostic workup excludes competing diagnoses. A better understanding of diagnostic patterns and criteria for knee pain will improve the quality and interpretation from epidemiological studies.

Active Duty Service Members Newly Presenting With Low Back Pain in Fiscal Year 2017: Health Care Utilization, Access to Care, and Private Sector Costs Over 2-year Follow-up.

INTRODUCTION: Low back pain (LBP) has accounted for the most medical encounters every year for the past decade among Active Duty Service Members (ADSMs) of the U.S. Armed Forces. The objectives of this retrospective, descriptive study were to classify LBP by clinical category (Axial, Radicular, and Other) and duration (Acute, Subacute, and Chronic) and examine the LBP-related health care utilization, access to care, and private sector costs for ADSMs over a 2-year follow-up period. MATERIALS AND METHODS: The Military Health System Data Repository was queried in fiscal year 2017 for all ADSMs (ages 18-62) with outpatient encounters documented with any of 67 ICD-10 diagnosis codes indicative of LBP. A 1-year clean period before the first (index) outpatient LBP encounter date was used to ensure no recent history of LBP care. Patients were eligible if continuously enrolled and on active duty for 1 year before and 2 years following the index visit. Patients were excluded for non-musculoskeletal causes for LBP, red flags, or acute trauma within 4 weeks of the index visit and/or systemic illness or pregnancy anytime during the clean or follow-up period. RESULTS: A total of 52,118 ADSMs met the inclusion criteria, and the cohort was classified by duration of LBP symptoms as Acute [17,916 (34.4%)], Subacute [4,119 (7.9%)], and Chronic [30,083 (57.7%)]. Over 2-year follow-up, 419,983 outpatient visits were recorded, with the majority occurring at MTFs [363,570 (86.6%)]. 13,237 (25.4%) of ADSMs in the total cohort were documented with no other LBP-related visits beyond their index encounter. In contrast, the Chronic cohort comprised the highest number of encounters [371,031 (89.2% of total encounters)], including 86% of imaging studies performed for LBP, and accounted for $9,986,606.17 (94.9%) of total private sector costs over the 2-year follow-up period. Interventional pain procedures ($2,983,767.50) and physical therapy ($2,298,779.07) represented the costliest categories in the private sector for the Chronic cohort, whereas Emergency Department ($283,307.43) and physical therapy ($137,035.54) encounters were the top contributors to private sector costs for the Acute and Subacute cohorts, respectively. Overall reliance on the private sector was highest for specialty care, including 10,721 (75.4%) interventional pain procedures and 306 (66.4%) spine surgeries. CONCLUSIONS: Uncovering current trends in health care utilization and access to care for ADSMs newly presenting with LBP is vital for timely and accurate diagnosis, as well as early intervention to prevent progression to chronic LBP and to minimize its negative impact on military readiness and quality of life. This retrospective, descriptive study highlights the burden of chronic LBP on health care utilization and costs within the Military Health System, including reliance on the private sector care, amounting to $10,524,332.04 over the study period.

Non-contact screening system based for COVID-19 on XGBoost and logistic regression.

BACKGROUND: The coronavirus disease (COVID-19) effected a global health crisis in 2019, 2020, and beyond. Currently, methods such as temperature detection, clinical manifestations, and nucleic acid testing are used to comprehensively determine whether patients are infected with the severe acute respiratory syndrome coronavirus 2. However, during the peak period of COVID-19 outbreaks and in underdeveloped regions, medical staff and high-tech detection equipment were limited, resulting in the continued spread of the disease. Thus, a more portable, cost-effective, and automated auxiliary screening method is necessary. OBJECTIVE: We aim to apply a machine learning algorithm and non-contact monitoring system to automatically screen potential COVID-19 patients. METHODS: We used impulse-radio ultra-wideband radar to detect respiration, heart rate, body movement, sleep quality, and various other physiological indicators. We collected 140 radar monitoring data from 23 COVID-19 patients in Wuhan Tongji Hospital and compared them with 144 radar monitoring data from healthy controls. Then, the XGBoost and logistic regression (XGBoost + LR) algorithms were used to classify the data according to patients and healthy subjects. RESULTS: The XGBoost + LR algorithm demonstrated excellent discrimination (precision = 92.5%, recall rate = 96.8%, AUC = 98.0%), outperforming other single machine learning algorithms. Furthermore, the SHAP value indicates that the number of apneas during REM, mean heart rate, and some sleep parameters are important features for classification. CONCLUSION: The XGBoost + LR-based screening system can accurately predict COVID-19 patients and can be applied in hotels, nursing homes, wards, and other crowded locations to effectively help medical staff.

[Device associated infection in medical surgical intensive care unit inpatients of an A level, tertiary class hospital in Beijing].

OBJECTIVE: To understand the situation of the device-associated infection (DAI) in the medical-surgical intensive care unit(ICU)inpatients in an A-level tertiary class hospital in Beijing. METHODS: DAI date were collected through a surveillance on the medical-surgical ICU inpatients in an A-level tertiary class hospital in Beijing from January 2008 to December 2010. RESULTS: In 2279 patients admitted to the medical-surgical ICU (with a 15,332 days total hospitalization stay), 283 were found infected. The incidence for in-hospital infection was 12.42%, and 2.452% for the incidence per patient-day. The device utilization ratios for ventilator, central venous catheter and urinary catheter were 56.76%, 59.01% and 80.07% respectively while the incidence for ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) were 1.632%, 0.409% and 0.350% respectively. The predominant bacteria species found in these cases were Gram-negatives and the main stay of pathogenic species were A. baumannii, P. aeruginosa, Staphylococcus, E. coli, K. pneumoniae and C. albicans etc. CONCLUSION: The incidence of DAI in the surveyed hospital is close to other hospitals in China and other developing countries but higher than hospitals in United States. More efforts should be made for its prevention / control by hospital stuff, with the cooperation from the patients.

In vitro responses to platelet-rich-plasma are associated with variable clinical outcomes in patients with knee osteoarthritis.

Autologous blood-derived products such as platelet-rich plasma (PRP) are widely used to treat musculoskeletal conditions, including knee osteoarthritis (OA). However, the clinical outcomes after PRP administration are often variable, and there is limited information about the specific characteristics of PRP that impact bioactivity and clinical responses. In this study, we aimed to develop an integrative workflow to evaluate responses to PRP in vitro, and to assess if the in vitro responses to PRP are associated with the PRP composition and clinical outcomes in patients with knee OA. To do this, we used a coculture system of macrophages and fibroblasts paired with transcriptomic analyses to comprehensively characterize the modulation of inflammatory responses by PRP in vitro. Relying on patient-reported outcomes and achievement of minimal clinically important differences in OA patients receiving PRP injections, we identified responders and non-responders to the treatment. Comparisons of PRP from these patient groups allowed us to identify differences in the composition and in vitro activity of PRP. We believe that our integrative workflow may enable the development of targeted approaches that rely on PRP and other orthobiologics to treat musculoskeletal pathologies.

Detecting SARS-CoV-2 in the Breath of COVID-19 Patients.

In the COVID-19 outbreak year 2020, a consensus was reached on the fact that SARS-CoV-2 spreads through aerosols. However, finding an efficient method to detect viruses in aerosols to monitor the risk of similar infections and enact effective control remains a great challenge. Our study aimed to build a swirling aerosol collection (SAC) device to collect viral particles in exhaled breath and subsequently detect SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR). Laboratory tests of the SAC device using aerosolized SARS-CoV-2 pseudovirus indicated that the SAC device can produce a positive result in only 10 s, with a collection distance to the source of 10 cm in a biosafety chamber, when the release rate of the pseudovirus source was 1,000,000 copies/h. Subsequent clinical trials of the device showed three positives and 14 negatives out of 27 patients in agreement with pharyngeal swabs, and 10 patients obtained opposite results, while no positive results were found in a healthy control group (n = 12). Based on standard curve calibration, several thousand viruses per minute were observed in the tested exhalations. Furthermore, referring to the average tidal volume data of adults, it was estimated that an exhaled SARS-CoV-2 concentration of approximately one copy/mL is detectable for COVID-19 patients. This study validates the original concept of breath detection of SARS-CoV-2 using SAC combined with RT-PCR.